Matching Patients to Sleep Breathing Therapy

Transcription

1 Matching Patients to Sleep Breathing Therapy Steve Carstensen DDS Diplomate, American Board of Dental Sleep Medicine Disclosures I have no financial relationships with any product mentioned in this talk. I am Editor in Chief of Dental Sleep Practice Magazine. Nasal Airway Nasopharynx Palate Oropharynx Hypopharynx

2 Mandibular Protrusion

3 Oral Appliance Types Mono-block articulation (TMJ) Hinge-based articulation (TMJ & incisors) Compression-based articulation (lower canine) Mono-block Hinge-based articulation Compression-based articulation Traction-based articulation (pre-molars & canine) Traction-based articulation (rear-molars) Tractionbased articulation Traction-based articulation Slide courtesy of ResMed

4 Materials 3D Jaw Position Record Allergenic Adjustable Bondable Best Feature Powder/Liquid PMMA Polycarbonate Adaptable Low Bulk Nylon yes Toughness Processed PMMA Millable Cast Metal yes Longevity George Gauge 2 and 5 mm forks determine distance between incisors Simple Measurement

5 Pro Gauge 6, 9 and 12 mm forks determine distance between incisors Simple Measurement

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8 Patient Appliance Matching Appliance Expectations Physical Dexterity Appliance Design Know Your Work Know Your Patient Insurance Considera tions Psychological Concerns Appliance Features Treatment History First, there is PAP CPAP BiPAP APAP VPAP ASV

9 History Have They Worn An Appliance Before? Dexterity / Vision Can They Make The Adjustments? Mobility Can They Open Wide Enough? Tooth Support Periodontally Stable? Enough Teeth?

10 Retention Will The Appliance Stay In Place? Toughness Will The Appliance Take What They Will Dish Out? Belief

11 Appliance Categories Tongue Retaining Devices Easy to Use Patient Compliance Issues Temporary Oral Appliances Silent Sleep (AKA: Easy Airway)

12 Silent Sleep (AKA: Easy Airway) Apnea Guard Fully Adjustable including in Lab Retentive but Flexible Moldable over Aligners Fixed Protrusion External Extension Remoldable Three Vertical Dimensions Rigid Arch Alignment Can Transfer Advancement Setting to the Custom MAD mytap Small Profile Readily Remoldable Fully Adjustable External Extension Titratable in Lab More Movement Possible Low Maintenance EMA Fragile Not For Bruxers Easy to Add Vertical User Friendly No Tongue Space Bulk Straps can Stretch, Reducing Advancement

13 Concerns About Mechanism Well Tested Widely Available Easy to Adjust Free Mandibular Movement Minimal Tongue Space Interference Great for TMD Patients Sleep Herbst Silent - Nite Weak not for bruxers! Adjusts in Steps Lateral Connectors Have Sliders Posts Break Often Occlusion is not Stable Inexpensive Simple Good Trial Appliance Dorsal Devices Fully Adjustable MAD Can Add More Protrusion Allows Mouth Opening unless Elastics are Added Retention Not Critical Very Good Patient Acceptance Watch for Asymmetric Adjustment There are many Similar Designs Easy to Add More Protrusion and Vertical Support Somewhat Rigid Mandibular Positioning Needs Excellent Retention Very Good Patient Acceptance Very Easy Adjustments Customizable to Add PAP DreamTAP

14 Wide Range of Adjustments CAD-CAM Aligned with Occlusal Plane Narval ProSomnus Lab Methylmethacrylate ProSomnus IA Easy for Patients to Adjust Least Bulky Appliance Low Overall Cost No adjustments advance with different parts CAD-CAM Reproducible Easy to Mold in Office No Headstraps or Leakage Surprise the Sleep Docs Very Good Patient Acceptance Best Option for Severe OSA Who Have Failed Both CPAP and OAT TAP - PAP You Must Master More Than One Appliance Become Adept at Several

15 What Records Do You Need? Excellent Impressions Excellent Impressions 3D Jaw Position Record What About Scans? MyTAP Customizable for Comfort Fully Adjustable Easy to Refit

16 Oral Appliance Delivery Exercises to Gain ROM Common Elements Discuss Possible Side Effects Talk About Cleaning What Should They Expect When Should They Return? Provide Written Materials

17 Improve Nasal Breathing Their Bite the Next Morning Will Not Be The Same

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20 Sleep Studies - What Do You Want To Know? Subjective: What Does the MD Say About Reasons? Sleep Study Subjective: What Does the MD Say About Reasons? Objective: The Data The Sleep Report Presents Assessment: the Interpretation Plan: What is the MD Thinking?

21 Sleep Study Objective: The Data The Sleep Report Presents Sleep Study Assessment: the Interpretation Sleep Study Plan: What is the MD Thinking? Steve Carstensen DDS Seattle Sleep Education SeattleSleepEducation.com Do You Have a Diagnosis? G47.33 Dental Sleep Practice Magazine Can You Make an Appliance? Prescription?

22 Steve Carstensen DDS Seattle Sleep Education